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Lam M, Garin E, Haste P, Denys A, Geller B, Kappadath SC, Turkmen C, Sze DY, Alsuhaibani HS, Herrmann K, Maccauro M, Cantasdemir M, Dreher M, Fowers KD, Gates V, Salem R. Utility of pre-procedural [ 99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of 90Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [ 99mTc]TcMAA-based Segmentation. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06920-6. [PMID: 39331131 DOI: 10.1007/s00259-024-06920-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE Pre-treatment [99mTc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [99mTc]TcMAA-based segmentation of tumor and normal tissue compartments. MATERIALS AND METHODS Included patients had HCC treated by glass [90Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [99mTc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [99mTc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [99mTc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson's correlation coefficient. RESULTS A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [99mTc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01-1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04-1.37; p = 0.012) for [99mTc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714-0.954; p = 0.009) and 0.847 (95% CI: 0.765-0.936; p = 0.001) for anatomic and [99mTc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson's correlation coefficient = 0.80). CONCLUSION Real-world data support [99mTc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [90Y]yttrium microspheres. Both anatomic and [99mTc]TcMAA threshold methods were suitable for treatment planning. TRIAL REGISTRATION NUMBER NCT03295006.
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Affiliation(s)
- Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Huispostnummer E01.132. Postbus 85500, Utrecht, 3508 GA, The Netherlands.
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - Etienne Garin
- Nuclear Medicine Department, Eugene Marquis Center, Rennes, France
| | - Paul Haste
- Department of Clinical Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | - Brian Geller
- Department of Radiology, University of Florida, Gainesville, FL, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cuneyt Turkmen
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford University, Stanford, CA, USA
| | | | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium (TKTK)-University Hospital Essen, Essen, Germany
| | - Marco Maccauro
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Murat Cantasdemir
- Division of Interventional Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | | | | | - Vanessa Gates
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Gupta A, Kulkarni S, Soman S, Saha M, Kulkarni J, Rana K, Dhas N, Ayesha Farhana S, Kumar Tiyyagura P, Pandey A, Moorkoth S, Mutalik S. Breaking barriers in cancer management: The promising role of microsphere conjugates in cancer diagnosis and therapy. Int J Pharm 2024; 665:124687. [PMID: 39265846 DOI: 10.1016/j.ijpharm.2024.124687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/29/2024] [Accepted: 09/07/2024] [Indexed: 09/14/2024]
Abstract
Cancer is a significant worldwide health concern, and there is a demand for ongoing breakthroughs in treatment techniques. Microspheres are among the most studied drug delivery platforms for delivering cargo to a specified location over an extended period of time. They are biocompatible, biodegradable, and capable of surface modifications. Microspheres and their conjugates have emerged as potential cancer therapeutic options throughout the years. This review provides an in-depth look at the current advancements and applications of microspheres and their conjugates in cancer treatment. The review encompasses a wide array of conjugates, ranging from polymers such as ethyl cellulose and Eudragit to stimuli-responsive polymers, proteins, peptides, polysaccharides such as HA and chitosan, inorganic metals, aptamers, quantum dots (QDs), biomimetic conjugates, and radio conjugates designed for radioembolization. Conjugated microspheres precisely deliver chemotherapeutics to the intended target while achieving controlled drug release to prevent side effects. It offers a means of integrating several distinct therapeutic modalities (chemotherapy, photothermal therapy, photodynamic therapy, radiotherapy, immunotherapy, etc.) to provide synergistic effects during cancer treatment. This review offers insights into the prospects and evolving role of microspheres and their conjugates in the dynamic landscape of cancer therapy. This review provides a comprehensive resource for researchers and clinicians working towards advancements in cancer treatment through innovative applications in therapy and translational research.
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Affiliation(s)
- Ashutosh Gupta
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Sanjay Kulkarni
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Soji Soman
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Moumita Saha
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Jahnavi Kulkarni
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Komal Rana
- Manipal - Government of Karnataka Bioincubator, 3rd Floor, Advanced Research Centre, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Namdev Dhas
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Syeda Ayesha Farhana
- Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraidah, Qassim 51452, Saudi Arabia
| | - Pavan Kumar Tiyyagura
- Department of Chemical Engineering, Manipal Institute of Technology Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Abhijeet Pandey
- Global Drug Development/ Technical Research and Development, Novartis Healthcare Private Limited, Genome Valley, Hyderabad 500081, Telangana, India
| | - Sudheer Moorkoth
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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Sandow T, Gimenez J, Nunez K, Tramel R, Gilbert P, Oliver B, Cline M, Fowers K, Cohen A, Thevenot P. Using Voxel-Based Dosimetry to Evaluate Sphere Concentration and Tumor Dose in Hepatocellular Carcinoma Treated with Yttrium-90 Radiation Segmentectomy with Glass Microspheres. J Vasc Interv Radiol 2024:S1051-0443(24)00467-6. [PMID: 39047936 DOI: 10.1016/j.jvir.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE To utilize voxel-based dosimetry following radiation segmentectomy (RS) to understand microsphere distribution and validate current literature regarding radiologic and pathologic outcomes. MATERIALS AND METHODS A retrospective, single-center analysis of patients with solitary hepatocellular carcinoma (N = 56) treated with yttrium-90 (90Y) RS with glass microspheres (Therasphere; Boston Scientific, Marlborough, Massachusetts) from 2020 to 2022 was performed. Posttreatment voxel-based dosimetry was evaluated using Mirada DBx Build 1.2.0 Simplicit90Y software (Boston Scientific) and utilized to calculate sphere concentration to tumor as well as D70 (minimum dose to 70% total tumor volume), D90, and D99. Time to progression (TTP), treatment response, and adverse events were studied. RESULTS Fifty-six solitary tumors were analyzed with a median tumor diameter of 3.4 cm (range, 1.2-6.8 cm) and median tumor absorbed dose of 732 Gy (range, 252-1,776 Gy). Median sphere activity (SA) at the time of delivery was 1,446 Bq (range, 417-2,621 Bq). Median tumor sphere concentration was 12,868 spheres/mL (range, 2,655-37,183 spheres/mL). Sphere concentration into tumor and normal tissue was inversely correlated with perfused treatment volume (R2 = 0.21 and R2 = 0.39, respectively). Of the 51 tumors with posttreatment imaging, objective response was noted in 49 patients (96%) and complete response in 42 patients (82%). The median TTP was not reached with a 2-year progression rate of 11%. Fifteen patients underwent liver transplant. Median tumor necrosis was 99% (range, 80%-100%). Lower tumor volumes and higher D99 were associated with complete pathologic necrosis (P < .001 and P = .022, respectively). CONCLUSIONS Voxel-based dosimetry following 90Y radioembolization can be utilized to account for sphere deposition and distribution into tumor. Ablative RS with high SA yields durable radiologic and pathologic outcomes.
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Affiliation(s)
- Tyler Sandow
- Department of Radiology, Ochsner Health, New Orleans, Louisiana.
| | - Juan Gimenez
- Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Kelley Nunez
- Institute of Translational Research, Ochsner Health, New Orleans, Louisiana
| | - Richard Tramel
- Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Patrick Gilbert
- Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Brianna Oliver
- Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Michael Cline
- Department of Radiology, Ochsner Health, New Orleans, Louisiana
| | - Kirk Fowers
- Boston Scientific Corporation, Marlborough, Massachusetts
| | - Ari Cohen
- Multi-Organ Transplant Institute, Ochsner Health, New Orleans, Louisiana
| | - Paul Thevenot
- Institute of Translational Research, Ochsner Health, New Orleans, Louisiana
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Kühnel C, Köhler A, Brachwitz T, Seifert P, Gühne F, Aschenbach R, Freudenberg R, Freesmeyer M, Drescher R. Clinical Results of Holmium-166 Radioembolization with Personalized Dosimetry for the Treatment of Hepatocellular Carcinoma. J Pers Med 2024; 14:747. [PMID: 39064001 PMCID: PMC11278198 DOI: 10.3390/jpm14070747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Transarterial radioembolization (TARE) with 166Ho-loaded microspheres is an established locoregional treatment for hepatocellular carcinoma (HCC), introduced in 2010. This study evaluates the clinical outcome of patients with HCC who underwent 166Ho-TARE with personalized dosimetry. Twenty-seven patients with 36 TARE procedures were analyzed. Treatment planning, execution, and evaluation was possible without complications in all cases. At the 3-month follow-up, disease control in the treated liver was achieved in 81.8% of patients (complete remission, partial remission, and stable disease in 36.4%, 31.8%, and 13.6%, respectively). The median overall survival (OS) was 17.2 months, and progression-free survival (PFS) in the treated liver was 11 months. Statistically significant positive correlations were observed between the achieved radiation dose for the tumor and both PFS (r = 0.62, p < 0.05) and OS (r = 0.48, p < 0.05), suggesting a direct dose-response relationship. The calculated achieved dose was 8.25 Gy lower than the planned dose, with relevant variance between planned and achieved doses in individual cases. These results confirm the efficacy of the 166Ho-TARE holmium platform and underscore the potential of voxel-based, personalized dosimetry to improve clinical outcomes.
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Affiliation(s)
- Christian Kühnel
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
| | - Alexander Köhler
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
| | - Tim Brachwitz
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
| | - Philipp Seifert
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
| | - Falk Gühne
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
| | - René Aschenbach
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Robert Freudenberg
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, 01307 Dresden, Germany
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
| | - Robert Drescher
- Clinic of Nuclear Medicine, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (C.K.)
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Mirza-Aghazadeh-Attari M, Srinivas T, Kamireddy A, Kim A, Weiss CR. Radiomics Features Extracted From Pre- and Postprocedural Imaging in Early Prediction of Treatment Response in Patients Undergoing Transarterial Radioembolization of Hepatic Lesions: A Systematic Review, Meta-Analysis, and Quality Appraisal Study. J Am Coll Radiol 2024; 21:740-751. [PMID: 38220040 DOI: 10.1016/j.jacr.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Transarterial radioembolization (TARE) is one of the most promising therapeutic options for hepatic masses. Radiomics features, which are quantitative numeric features extracted from medical images, are considered to have potential in predicting treatment response in TARE. This article aims to provide meta-analytic evidence and critically appraise the methodology of radiomics studies published in this regard. METHODS A systematic search was performed on PubMed, Scopus, Embase, and Web of Science. All relevant articles were retrieved, and the characteristics of the studies were extracted. The Radiomics Quality Score and Checklist for Evaluation of Radiomics Research were used to assess the methodologic quality of the studies. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve in predicting objective response were determined. RESULTS The systematic review included 15 studies. The average Radiomics Quality Score of these studies was 11.4 ± 2.1, and the average Checklist for Evaluation of Radiomics Research score was 33± 6.7. There was a notable correlation (correlation coefficient = 0.73) between the two metrics. Adherence to quality measures differed considerably among the studies and even within different components of the same studies. The pooled sensitivity and specificity of the radiomics models in predicting complete or partial response were 83.5% (95% confidence interval 76%-88.9%) and 86.7% (95% confidence interval 78%-92%), respectively. CONCLUSION Radiomics models show great potential in predicting treatment response in TARE of hepatic lesions. However, the heterogeneity seen between the methodologic quality of studies may limit the generalizability of the results. Future initiatives should aim to develop radiomics signatures using multiple external datasets and adhere to quality measures in radiomics methodology.
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Affiliation(s)
- Mohammad Mirza-Aghazadeh-Attari
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Tara Srinivas
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Arun Kamireddy
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Alan Kim
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland.
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Safavi AH, Dawson LA, Mesci A. Do We Have a Winner? Advocating for SBRT in HCC Management. Clin Transl Radiat Oncol 2024; 45:100740. [PMID: 38380116 PMCID: PMC10876598 DOI: 10.1016/j.ctro.2024.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Abstract
•Stereotactic body radiotherapy (SBRT) is a safe and effective locoregional therapy for inoperable patients with HCC.•SBRT compares favorably with other local therapies in terms of local control, survival, morbidity, and cost-effectiveness.•SBRT should be considered and discussed in multidisciplinary management of appropriate HCC patients.•Advances in SBRT and novel combinations with systemic therapy may further widen the therapeutic index in HCC.
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Affiliation(s)
- Amir H. Safavi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Laura A. Dawson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aruz Mesci
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Doyle PW, Workman CS, Grice JV, McGonigle TW, Huang S, Borgmann AJ, Baker JC, Duncan DP, Taylor JE, Brown DB. Predictive Dosimetry and Outcomes of Hepatocellular Carcinoma Treated by Yttrium-90 Resin Microsphere Radioembolization: A Retrospective Analysis Using Technetium-99m Macroaggregated Albumin Single Photon Emission CT/CT and Planning Software. J Vasc Interv Radiol 2024:S1051-0443(24)00026-5. [PMID: 38246416 DOI: 10.1016/j.jvir.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/11/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To characterize estimated mean absorbed tumor dose (ADT), objective response (OR), and estimated target dose of hepatocellular carcinoma (HCC) after resin microsphere yttrium-90 (90Y) radioembolization using partition dosimetry. MATERIALS AND METHODS In this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between October 2015 and June 2022 was performed using a commercial software package and pretreatment technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT)/computed tomography (CT). In total, 101 patients with HCC underwent 102 treatments of 127 index tumors. Patients underwent imaging every 2-3 months after treatment to determine best response per modified Response Evaluation Criteria in Solid Tumors (mRECIST). Best response was defined as the greatest response category per mRECIST and categorized as OR or nonresponse (NR). A Cox proportional hazards model evaluated the probability of tumor OR and progression-free survival using ADT. RESULTS The median follow-up period was 148 days (interquartile range [IQR], 92-273 days). The median ADT of OR was 141.9 Gy (IQR, 89.4-215.8 Gy) compared with the median ADT of NR treatments of 70.8 Gy (IQR, 42.0-135.3 Gy; P < .001). Only ADT was predictive of response (hazard ratio = 2.79 [95% confidence interval {CI}: 1.44-5.40]; P = .003). At 6 months, an ADT of 157 Gy predicted 90.0% (95% CI: 41.3%-98.3%) probability of OR. At 1 year, an ADT of 157 Gy predicted 91.6% (95% CI: 78.3%-100%) probability of progression-free survival. Partition modeling and delivered activity were predictive of progression (P = .021 and P = .003, respectively). CONCLUSIONS For HCC treated with resin microspheres, tumors receiving higher ADT exhibited higher rates of OR. An ADT of 157 Gy predicted 90.0% OR at 6 months.
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Affiliation(s)
- Patrick W Doyle
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Spencer Workman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared V Grice
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trey W McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Duncan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason E Taylor
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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